Offsite intravenous admixture center shared by health-system facilities

The creation of an offsite i.v. admixture center shared by four affiliated health care facilities is described. The i.v. admixture center was developed to consolidate the admixture services of four Carilion Health System (Roanoke, Virginia)-affiliated facilities: Roanoke Memorial Hospital (RMH), RMH's Cancer and Rehabilitation Center, Community Hospital of Roanoke Valley (CHRV), and the Roanoke Memorial Home Health Parenteral Therapy Program. The proposed advantages of a shared i.v. admixture service included providing full i.v. services for CHRV, increasing the ability to prepare home i.v. admixtures on a daily basis, increasing space for preparing i.v. admixtures, avoiding adding admixture staff members at any of the facilities, reducing supply duplication and admixture waste, and standardizing and improving quality. The Carilion Admixture Center was built in Carilion's materials management building at a total cost for construction and new equipment of $80,000; it opened in April 1992. The facility is responsible for providing piggyback admixtures, premixed piggyback solutions, injectable antineoplastic agents, total parenteral nutrient solutions, prefilled syringes for pediatric patients, large-volume solutions containing additives, and all admixtures required for the home health care patients. The facility was certified as a Class 20,000 environment. Start-up problems included computer glitches and a heavier-than-anticipated workload during the first year of operation. Nearly 700,000 i.v. admixtures were compounded at the center between October 1992 and September 1994. There were 95 reports of missing doses during the day shift at RMH between November 1992 and January 1993; only 6% were due to errors at the admixture center. The estimated total cost avoidance for salaries, benefits, and nonbillable supplies for October 1992 through September 1994 was $437,000. Intravenous admixture services provided by three hospital facilities and one home health agency were successfully consolidated into one shared offsite center.

Lessons in cooperation: four hospital consortia relate their quality improvement experiences

BACKGROUND

In 1989, The Robert Wood Johnson Foundation launched a demonstration project to test a consortium approach to quality improvement. As part of this project, four hospital consortia in various parts of the United States are currently sharing quality resources (for example, training) and collaborating on various improvement efforts. The purpose of the project is to demonstrate that hospitals can take on more difficult problems and accomplish more in cooperation with each other than on their own.

CASE STUDIES

The Institute for Quality Healthcare (Iowa City, Iowa) has built a comparative database so that 40 member hospitals can make meaningful comparisons on various aspects of performance; The Vermont Program for Quality in Health Care has lowered the postoperative infection rate in Vermont by monitoring compliance with consensus guidelines; Interwest Quality of Care, Inc, which has member organizations in Utah, Wyoming, and Idaho, has adapted and disseminated guidelines for diabetic care; and The Public Hospital Institute, in Berkeley, California, has worked with the Joint Commission on Accreditation of Healthcare Organizations to develop a written guide to help surveyors understand the unique operational traits of public hospitals.

LESSONS LEARNED

Projects such as those with champions in several member organizations and comparative data analysis lend themselves more easily to cooperative work than others. They also provide some strategies for collaboration, such as continually reinforcing the principles of collaboration, obtaining a fully informed commitment, beginning with initiatives that are likely successes, and being serious and vocal about the commitment to confidentiality.

CONCLUSIONS

Collaborators in quality improvement gain important resources, such as better information, more relevant reference databases, colleagues and support for quality improvement specialists, and economies of scale in education programs, training materials, and interaction with vendors. However, the difficulties in collaboration are great. Hospitals must continually consider not only "What's in this for me," but also "What can we accomplish as a group that is greater than what each of us can do alone?"

Centralized off-premise transcription service: a model

The use of typewritten records in emergency departments can provide better documentation and can impact reimbursement, continuous quality improvement, and medicolegal aspects of emergency care. An easily accessible system, which provides for a uniform, typewritten record within a short turnaround time, has been implemented by a private emergency medicine group. The system has had a positive impact on reimbursement and efficient patient care. It may also be used for teaching and research as well as personal business. A centralized off-premise transcription service allows for 24-h dictation for multiple hospitals in a cost-efficient manner. System drawbacks are minor and start-up problems easily overcome.

Food on the move--tales from two cities

As consolidation & downsizing become more & more common in all segments of noncommercial foodservice, so does centralized food production & with it, the satelliting of food. In these case studies, two foodservice directors share their experiences in planning, implementing & managing successful satellite foodservice programs.

Two hospitals join forces to sponsor "A Woman's Comfort Day"

Two Baton Rouge, La., hospitals--usually strong competitors--decided to join forces and collaborate on a special event for the women of the community. "A Woman's Comfort Day," now in its third year, was the successful result. If they're feeling good about themselves, can the Super Bowl be far behind?

How a three-campus heart service line improves clinical processes and outcomes

BACKGROUND

In 1993, Intermountain Health Care's three Salt Lake Valley Hospitals formed service lines in four clinical areas, one of which was heart services. After experimenting with various organizational structures, the Salt Lake Valley Hospitals formed a cardiac executive council and three specialty work teams--the clinical process and outcome, satisfaction, and resource teams--to allow for unified planning and greater teamwork. CASE STUDY--OPEN HEART TEAM: The team mapped out the current process and identified areas for potential improvement in the care of patients undergoing coronary artery bypass graft (CABG) surgery. One of the key processes selected for study was extubation. Patients were extubated for an average of 20.41 hours (range, 6 to 120 hours). Analysis of practice patterns demonstrated that extubation was related to staffing patterns, not the patient's readiness. The team created a weaning path, which reduced extubation time to an average of 8.89 hours.

LESSONS LEARNED

A common vision and an organized structure to support integrated services is essential. Cross-training of staff helps ensure that the same standards of care apply across the three campuses. Even when the medical staff and hospital departments each have their own structures for dealing with quality issues, cohesiveness among physicians treating a certain group of patients, such as cardiac patients, can be promoted. In conclusion, a "cardiac culture" that is evident throughout the three hospitals promotes performance improvement.

Development opportunities for hospital clinical laboratory joint ventures

Regional health-care providers are being given the opportunity to collaborate in specialty health-care services. Collaboration to achieve superior economies of scale is very effective in the clinical laboratory industry. National laboratory chains are consolidating and enhancing their control of the industry to ensure their historic profitability. National companies have closed many laboratory facilities and have laid off substantial numbers of laboratory personnel. Health-care providers can regain control of their locally generated laboratory health-care dollars by joining forces with clinical laboratory joint ventures. Laboratorians can assist the healthcare providers in bringing laboratory services and employment back to the local community. New capital for operational development and laboratory information systems will help bring the laboratory to the point of care. The independent regional laboratory is focused on supporting the medical needs of the community. The profit generated from a laboratory joint venture is shared among local health-care providers, supporting their economic viability. The laboratories' ability to contribute to the development of profit-making ventures will provide capital for new laboratory development. All of the above will ensure the clinical laboratories' role in providing quality health care to our communities and employment opportunities for laboratory personnel.

Rural hospital networks: implications for rural health reform

This article summarizes the perspectives gained in the course of evaluating a 4-year demonstration program that supported rural hospital networks as mechanisms for improving rural health care delivery. Findings include: (1) joining a network is a popular, low-cost strategic response for rural hospitals in an uncertain environment; (2) rural hospital network survival is enhanced by the mutual resource dependence of members and the presence of a formalized management structure; (3) rural hospitals join networks primarily to improve cost efficiency but, on average, hospitals do not appear to realize short-term economic benefit from network membership; and (4) some of the benefits of these networks may be realized outside of the communities in which rural hospitals are located.

Hospitals seek strength in numbers

Six Iowa hospitals that don't have a common owner are banding together to form a health information network using a software system that they couldn't have afforded individually. The network will provide easy access to electronic records throughout a broad, rural area.

New South Wales group pathology services--the Southpath model

There has been significant rationalisation of public pathology service provision in New South Wales through the formation of group pathology services. These services are a fundamental change in the method of service organisation and delivery and little has been reported detailing their organisational and financial structures. Southpath, the group pathology service of the Southern Sydney Area Health Service, has improved service delivery, improved productivity by 18.2 per cent and reduced pathology expenditure per admission by 19.2 per cent. This paper describes the organisation of Southpath as knowledge of the organisational structures and performance of the group pathology service is necessary for the evaluation of this change in the method of service delivery and is essential to the current debate on the value of public pathology services.

Consolidating ancillary testing in multihospital systems

This article introduces a new initiative that allows medical centers to establish uniformity and quality management of laboratory diagnostic testing performed in on-site and outreach locations for hospitalized inpatients and ambulatory care patients. This article also reviews the requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) and how they affect ancillary testing sites.

Partners in nursing education

In this article, the authors present the efforts of several hospitals in a large southern city to collaborate on continuing education projects to meet the needs of the nursing staff. In 1985, four hospitals formed a health maintenance organization. An outgrowth was the formation of a critical care consortium whose main objective was to develop an entry level critical care course. The authors discuss the development of this course, the advantages and disadvantages of a partnership, and the results of 7 years of experience.

Hamilton Health Sciences Laboratory Program: a provider developed model for hospital, university and community laboratory services

Clinical Laboratory Sciences are under pressure to reduce the number of tests and cut staff and supply costs. The ability of academic centres to continue to deliver high quality service, teaching and research is threatened. In difficult economic times imaginative strategies are needed to look for solutions which will permit continued advancement in academic and clinical standards. Rationalization of service and cost-effective use of resources are not new concepts; however, there is a scarcity of models which have been developed and promoted by the providers of laboratory services, rather than those imposed by governments and other paying agencies. A model developed and evolved over the last two decades by The Hamilton Health Sciences Laboratory Program (HHSLP) is outlined.